Updated June 08, 2015.
We are in the midst of a contentious debate over the future of our healthcare system, in which the opposing parties find almost nothing in common. But there is one thing everybody agrees upon - Republicans and Democrats, Keynsians and Reaganites, Buckeyes and Wolverines alike. Namely, robust primary care medicine is the backbone of healthcare, and whatever else we may end up doing, we need to re-invigorate primary care and restore it to the position of central importance it deserves.
To the notion that primary care medicine is vitally important to American patients, DrRich says hooray. To the notion that anyone with authority in our healthcare system actually wants to fix primary care, however, DrRich says hooey.
The fact of the matter is that in recent years, our healthcare system has taken exquisite pains to make primary care a completely untenable proposition for American doctors. Consider the plight of the modern primary care physician (PCP):
The idea that the central authorities of healthcare are going to cede back to PCPs any degree of professionalism or independent thought - when strictly controlling the behavior of PCPs is Job One in their effort to reduce costs, and when they've worked so hard to put the PCPs where they've now got them - is laughable.
The plan, DrRich believes, is to give PCPs a few perks - a small increase in their paltry pay, for instance - to entice them to not to quit just yet, while they "train up" a new class of professionals who eventually will take over the job of primary care from the physicians, and who (they think) will be more malleable and controllable than physicians ever could be. At the moment, nurse practitioners have been identified as a likely PCP replacement.
Indeed, the House healthcare reform bill (HR 3692, Section 1303) specifically enumerates nurse practitioners as members of the category "PCPs" (a term now defined as "primary care practitioner," and not "primary care physician"). So soon, nurses will be, by law, functionally equivalent to doctors practicing primary care.
DrRich happens to greatly admire nurses, counts some of them among the finest healthcare professionals he has known, and believes that nurses' commitment to doing what's best for patients is at least equivalent to physicians'. Furthermore, he is convinced that nurses can function just fine as primary care practitioners, as the central authorities have now fashioned that profession. To the degree that nurses will chafe less than doctors at the forced restrictions, they may even function better.
Indeed, DrRich's respect for nurses is so great that he predicts most of them will forego the opportunity to become PCPs for the same reason doctors are - doing this job as it is now laid out, they will find, is an insult to their professional integrity.
But whether the central planners' vision comes to pass or not, DrRich finds their current lamentations for the plight of PCPs (a plight they engineered) to be just a tad disingenuous, and certainly overblown.
More of the Top 10 Overblown Health Stories of the Decade.
We are in the midst of a contentious debate over the future of our healthcare system, in which the opposing parties find almost nothing in common. But there is one thing everybody agrees upon - Republicans and Democrats, Keynsians and Reaganites, Buckeyes and Wolverines alike. Namely, robust primary care medicine is the backbone of healthcare, and whatever else we may end up doing, we need to re-invigorate primary care and restore it to the position of central importance it deserves.
To the notion that primary care medicine is vitally important to American patients, DrRich says hooray. To the notion that anyone with authority in our healthcare system actually wants to fix primary care, however, DrRich says hooey.
The fact of the matter is that in recent years, our healthcare system has taken exquisite pains to make primary care a completely untenable proposition for American doctors. Consider the plight of the modern primary care physician (PCP):
- Their pay is determined arbitrarily by Acts of Congress, not by what they’re worth to their patients or to the market, and indeed in this way PCPs have a lot in common with workers in the old Soviet collectives.
- They are directed to “practice medicine” by guidelines handed down from on high; guidelines which, being forcibly based on what is called “evidence-based medicine,” necessarily address the average response of some large group of patients to the treatment being considered and do not allow much if any latitude for an individual patient’s needs; and which are often promulgated less to assure the excellent care of patients than to further the agenda of various interest groups, professional, governmental and otherwise.
- They are limited to 7.5 minutes per "patient encounter," and the content of those 7.5 minutes is scripted in advance by Pay for Performance checklists, strictly limiting any exchanges between doctor and patient that do not meet the approved agenda.
- Their every move must be carefully documented according to incomprehensible rules, on innumerable forms and documents, that confound patient care but that greatly further the convenience of healthcare accountants and other stone-witted bureaucrats.
- They are expected to operate flawlessly under a system of federal rules, regulations and guidelines that cover hundreds of thousands of pages distributed in countless volumes that are never available in any readily accessible form, and if they fail to do so, they are guilty of the federal crime of healthcare fraud. Furthermore, the specific meanings of these rules, regulations and guidelines are not merely opaque and difficult to ascertain, but indeed they are fundamentally indeterminate. So, PCPs operate under a massive quantum cloud of rules as best they can, but their actual status (regarding healthcare fraud) is, like Schrodinger’s cat, fundamentally unknowable - until the “box is opened” (typically through criminal prosecution), whereupon the meaning of the rules is finally crystallized in a court of law, and doctors who had been practicing in good faith find that they have at least a 50- 50 chance (like the cat) of learning that they are actually professionally dead.
- Worst of all, PCPs have been charged with the duty of covertly rationing their patients’ healthcare at the bedside, and they have been pressed to nullify the classic doctor-patient relationship, by the healthcare bureaucracy that determines their professional viability, by the United States Supreme Court, and by the bankrupt, new-age ethical precepts of their own profession.
The idea that the central authorities of healthcare are going to cede back to PCPs any degree of professionalism or independent thought - when strictly controlling the behavior of PCPs is Job One in their effort to reduce costs, and when they've worked so hard to put the PCPs where they've now got them - is laughable.
The plan, DrRich believes, is to give PCPs a few perks - a small increase in their paltry pay, for instance - to entice them to not to quit just yet, while they "train up" a new class of professionals who eventually will take over the job of primary care from the physicians, and who (they think) will be more malleable and controllable than physicians ever could be. At the moment, nurse practitioners have been identified as a likely PCP replacement.
Indeed, the House healthcare reform bill (HR 3692, Section 1303) specifically enumerates nurse practitioners as members of the category "PCPs" (a term now defined as "primary care practitioner," and not "primary care physician"). So soon, nurses will be, by law, functionally equivalent to doctors practicing primary care.
DrRich happens to greatly admire nurses, counts some of them among the finest healthcare professionals he has known, and believes that nurses' commitment to doing what's best for patients is at least equivalent to physicians'. Furthermore, he is convinced that nurses can function just fine as primary care practitioners, as the central authorities have now fashioned that profession. To the degree that nurses will chafe less than doctors at the forced restrictions, they may even function better.
Indeed, DrRich's respect for nurses is so great that he predicts most of them will forego the opportunity to become PCPs for the same reason doctors are - doing this job as it is now laid out, they will find, is an insult to their professional integrity.
But whether the central planners' vision comes to pass or not, DrRich finds their current lamentations for the plight of PCPs (a plight they engineered) to be just a tad disingenuous, and certainly overblown.
More of the Top 10 Overblown Health Stories of the Decade.
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